Choosing an Orthopaedic Surgeon for Joint Replacement Surgery

Choosing a surgeon to perform your joint replacement surgery can be daunting.  You want the best, but how do you know to choose the best?  You can choose based upon a referral from your personal physician, a friend or neighbor, or information gathered on the Internet.  A referral from a patient who has previously had surgery with a particular surgeon is often is best resource.  Such an individual can tell you about their experience and provide you with a “sounding board” for your own questions and concerns.

What should you find out about a surgeon who will potentially operate on you or a friend or loved one?  The following are questions that you should feel comfortable asking your (potential) surgeon:

What specialty training to you have in the area of joint replacement surgery?  Are you fellowship trained in joint replacement surgery?

While many orthopaedic surgeons will advertise themselves as “specialists”, not all surgeons have had the same training or have the same level of experience in the area of joint replacement surgery.  All orthopaedic surgeons are trained to perform joint replacement surgery during the course of their residency training program.  Does that make them an expert?  No.  Completion of a one year fellowship program after residency training will qualify a surgeon to take on the label of a “specialist” in joint replacement surgery. During this additional year of fellowship training, surgeons have the opportunity to receive specialized training under renowned, expert surgeons- honing the skills to perform surgery ranging from the most straight-forward to the most complex surgery.

 

How many hip, knee, or shoulder replacement surgeries have you performed?

Research has shown that surgeons who perform a high volume of joint replacement surgeries have better outcomes with regards:  lower complication rates, shorter length of hospital stay and reduced cost associated with the procedure.  The definition may vary, but a “high” volume total joint replacement surgeon will perform over 250 surgeries per year.

 

Do you perform revision or “redo” joint replacement surgery?

Only a small percentage of orthopaedic surgeons will take on the patient who requires a “revision” of a previous joint replacement.  These are the more difficult and complex surgeries that are usually best handled by the fellowship-trained joint replacement surgeon.

 

Do you perform minimally invasive surgery, such as Direct Anterior Total Hip Replacement?

Over the past 15 years, the ability to perform joint replacement surgery, especially hip replacement, has allowed surgeons to use the least invasive, also referred to as minimally invasive (MIS), techniques.  The Direct Anterior (DA) Total Hip replacement is performed through the front the hip/thigh, without the need to release or cut any muscle or tendons in the process of performing the surgery.  Research has shown that the DA technique reduces several risks associated with this surgery, including:  risk of dislocation, blood clots, and leg length discrepancy.  Evidence also shows that the technique helps facilitate the patients’ recovery in the first three months after surgery.

 

Do you use robotic-assisted technology for joint replacement surgery?

Computer-assisted and now robotic-assisted surgical techniques have continued to evolve over the past decade.  There are now two robotic-assisted platforms available for orthopaedic joint replacement surgery.  The first generation MAKOplasty technique uses a preoperative CT scan to help surgeons perform partial knee and hip replacements.

The NAVIO system is the second generation robotic-assisted technology that offers a novel “augmented reality” platform.  The technique allows the surgeon to create a three-dimensional model of the knee in real time during surgery.  With this model, the surgeon can optimize the decisions of implant placement and sizing leading to improved accuracy and precision of the surgery.   NAVIO was approved for partial knee replacement surgery in 2013 and is now also FDA approved for total knee replacement.

Because of the relatively new technology and still limited availability, not all surgeons have access to this technique for their patients.

 

What happens is I develop a complication after my surgery?

Your choice of surgeon should be based upon your knowledge of the skill and expertise of the surgeon and your comfort level and relationship with them.  A surgeon with a good bedside manner is a surgeon who will make your experience through the surgical process more personal and help reduce any concerns or anxiety that naturally arises when you are considering surgery.  Complications can and do occasionally arise during or after surgery.  Your level of confidence in your surgeon should help you to work through any challenges together.

 

There are many physician “rating” sites on the Internet- how do I know if they are accurate?

As time has taught us, it is buyer beware on the Internet.  There are many useful and information sites on the Internet to learn about physicians.  That does not mean they are all accurate.

One Phoenix based orthopaedic group offers the website headline that it is the “number one orthopedic group in 2013 and 2014 by Ranking Arizona”.   Should this type of self-promotion sway your decision?  A brief evaluation of the “Ranking Arizona” website should provide enough information to read between the lines.  The Ranking Arizona website encourages visitors to “Vote early and vote often” for their favorite businesses.  In other words, a business can have individuals (even their own employees) cast unlimited votes for themselves to help promote their business as “number one”.  This type of internet promotion, unfortunately, can easily mislead the consumer- in this situation, it can mislead a potential patient with regard the true reputation and quality of care offered by a physician or physician group.  Internet research can be helpful, but as with so many other things in life, information should be taken with a grain of salt.